Pick the right plan

When it comes to picking your health insurance plan, there are lots of things to pay attention to.

HMO’s, or Health Maintenance Organizations, are typically lower cost and have smaller, regional networks. You also may have to see your Primary Care Provider (PCP) before you go see a specialist. PPO’s, or Preferred Provider Organizations, usually have higher costs but have access to broad national networks. You won’t need to get a referral to go see a specialist either.

Both HMO’s and PPO’s are great options, and your decision should be based on what level of care you need and what costs you want the insurance company to cover.

You can pay for your medical bills in a few different ways. Copays are fairly standard in most health insurance plans, and is a fixed ‘fee for service’. You will typically pay a copay when you go visit your doctor or see a specialist. Your plan may also have a copay to get labs done, go to an urgent care, or even visit the Emergency Room.

Coinsurance kicks in when you have major medical needs like a surgery or birth of a child. There are also plans that specifically do not have any copays and only coinsurance. Coinsurance allows you to only pay a percentage of the total bill, leaving the insurance company to cover the rest. Usually, you have to hit your deductible before coinsurance kicks in.

The Deductible is your responsibility to pay before the insurance company starts paying coinsurance, or their portion of the medical bill. Deductibles range from as high as $6,600 per calendar year to as low as $0. After your deductible is reached that year, the insurance company then begins to pay a percentage of your medical expenses until you have reached your Out of Pocket Maximum.

Out of Pocket Maximum’s (OOPM) is the most you’ll ever pay in any given calendar year to receive care. Once you have hit the OOPM, your healthcare costs are completely covered by the insurance company.